Drinking Patterns (71)
Mediterranean diet, alcohol-drinking pattern and their combined effect on all-cause mortality: the Seguimiento Universidad de Navarra (SUN) cohort
By eboursPURPOSE: The health benefits of the Mediterranean diet (MedDiet) have been widely studied. However, controversy remains for one of its components: alcohol intake. We aimed to assess the joint effect of adherence to the MedDiet and alcohol-drinking pattern on all-cause mortality.
METHODS: We used data from 20,506 subjects from a prospective cohort of Spanish university graduates, the Seguimiento Universidad de Navarra (SUN) cohort. Adherence to the MedDiet was operationalized using four different dietary indexes and then categorized in low or high adherence, according to the median score. Alcohol-drinking pattern was evaluated with the previously defined the Mediterranean alcohol-drinking pattern (MADP), grouped into three categories of adherence (low, moderate and high adherence) and a fourth category for abstainers. The outcome was all-cause mortality.
RESULTS: During a median follow-up of 12.1 years, we observed 460 deaths. No statistically significant supra-multiplicative interaction between the two exposures was found. Low adherence to both the MedDiet and MADP was associated with higher all-cause mortality compared to high adherence to both exposures [multivariable-adjusted hazard ratio (HR) = 2.02, 95% confidence interval (CI): 1.33-3.07]. Similar results were found for cancer mortality and cardiovascular mortality.
CONCLUSIONS: Although the combined effect of the MedDiet and MADP was not significantly higher than the product of their individual effects, a low adherence to both the MedDiet and MADP was associated with higher rates of all-cause mortality. This report also shows the usefulness of the dietary pattern approach applied to alcohol intake and of including the drinking pattern as another component of the MedDiet.
Drinking to excess and the tipping point: An international study of alcohol intoxication in 61,000 people
By eboursBACKGROUND: People who drink alcohol often seek to manage their intake in order to maximise the pleasurable effects, such as feelings of sociability and relaxation, without reaching their 'tipping point', where they feel out of control, or unwell. This paper aimed to explore three stages of intoxication; feeling the effects; being as drunk as you would like to be; and reaching the tipping point (feeling more drunk than you want to be) in a large international sample.
METHODS: The Global Drug Survey (GDS) is an annual, cross-sectional, online survey of drug use. This paper draws on data from 61,043 respondents (63.7% male) from 21 countries who took part in GDS2015 collected in November 2014 to January 2015. Respondents reported their usual type of drink; how many drinks they would require to reach each stage of intoxication and how frequently they reached each stage. Alongside socio-demographic measures, they also completed the Alcohol Use Disorders Identification Test (AUDIT).
RESULTS: Male respondents reported consuming 87.55 gm to be as drunk as they want to be and female respondents reported 70.16 gm, on average. The tipping point was reached at 138.65 gm for male respondents and 106.54 gm for female respondents. Overall 20.3% reported reaching their tipping point at least once a month. Being male, aged under 25 and at higher risk for alcohol use disorder was associated with reporting reaching the tipping point more frequently.
CONCLUSIONS: The amount of alcohol being consumed to reach a desired point of intoxication is much higher than the maximum daily, and sometimes weekly, amount recommended by country guidelines. Encouraging people to avoid reaching their tipping point may be a useful intervention point alongside better communication of low risk drinking guidelines.
Perceived social capital and binge drinking in older adults: The Health and Retirement Study, US data from 2006-2014
By eboursOBJECTIVE: Social capital has been described as having both positive influences as well as negative influences ("the dark side") on health behaviors. We sought to test the association of perceived social capital on the risk of binge drinking among older adults, using a longitudinal design.
METHODS: We used HRS (Health and Retirement Study) data, a nationally representative sample of US adults aged >/=50 years evaluated every two years (from 2006 to 2014). We investigated the relationship between perceived social capital (neighborhood social cohesion and neighborhood physical disorder, positive social support and negative social support) and binge drinking over time, with a multilevel structural equation modelling (MSEM) approach, modelling number of binge-drinking days as hurdle negative binomial. We used MSEM estimating the associations at person level (overall) and within waves.
RESULTS: The sample included 19,140 individuals. At baseline mean age was 66.8 (SD 10.3). Over time, the number of binge drinking days decreased. Negative social support increased the average number of binge drinking days among those who drink, where one unit increase was associated with an increase of 37 % in the expected number of days binge drinking in the same wave. The association of positive social support on the number of binge drinking days was stronger for females (-0.59 (SE = 0.12)), while neighborhood social cohesion was significantly associated with binge drinking in females (-0.05 (SE = 0.01)), but not in males.
CONCLUSIONS: Negative social support favored binge drinking. Positive social support and neighborhood social cohesion are protective factors for binge drinking, especially for women.
The role of alcohol use and drinking patterns in socioeconomic inequalities in mortality: a systematic review
By eboursBACKGROUND: Individuals with low socioeconomic status (SES) experience disproportionately greater alcohol-attributable health harm than individuals with high SES from similar or lower amounts of alcohol consumption. Our aim was to provide an update of the current evidence for the role of alcohol use and drinking patterns in socioeconomic inequalities in mortality, as well as the effect modification or interaction effects between SES and alcohol use, as two potential explanations of this so-called alcohol-harm paradox.
METHODS: We did a systematic review, searching Embase, Medline, PsycINFO, and Web of Science (published between Jan 1, 2013, and June 30, 2019) for studies reporting alcohol consumption, SES, and mortality. Observational, quantitative studies of the general adult population (aged >/=15 years) with a longitudinal study design were included. Two outcome measures were extracted: first, the proportion of socioeconomic inequalities in mortality explained by alcohol use; and second, the effect modification or interaction between SES and alcohol use regarding mortality risks. This study is registered with PROSPERO (CRD42019140279).
FINDINGS: Of 1941 records identified, ten met the inclusion criteria. The included studies contained more than 400 000 adults, more than 30 000 deaths from all causes, and more than 3000 100% alcohol-attributable events. Alcohol use explained up to 27% of the socioeconomic inequalities in mortality. The proportion of socioeconomic inequalities explained systematically differed by drinking pattern, with heavy episodic drinking having a potentially significant explanatory value. Although scarce, there was some evidence of effect modification or interaction between SES and alcohol use.
INTERPRETATION: To reduce socioeconomic inequalities in mortality, addressing heavy episodic drinking in particular, rather than alcohol use in general, is worth exploring as a public health strategy.
FUNDING: Canadian Institutes of Health Research.
Changes in alcohol consumption in Spain between 1990 and 2019
By eboursSpain is one of the countries of the European Union in which alcohol consumption has decreased in the past decades. The aim of this paper is to distinguish different phases of the level of alcohol consumption in Spain since 1990. Adult alcohol consumption per capita data between 1990 and 2019 were analysed for temporal trends using the Joinpoint regression model. An additional analysis using interrupted time-series between 1962 and 2016 was performed using data from Global Information System on Alcohol and Health.
Data from the survey on alcohol and other drugs in Spain were collected and a narrative review was conducted to identify possible reasons for the trends found. Five point changes were identified on the timeline between 1990 and 2019, including: a decrease of 3.2% per year from 1990 to 1995, an increase of 1.1% per year from 1995 to 2000, a period of stability from 2000 to 2006, a decrease of 4.5% per year from 2006 to 2011, and a period of stability from 2011 onwards.
These changes can largely be explained by the different public health measures carried out by the Spanish government, as well as the change in the pattern of consumption in society, which shifted its alcoholic beverage preference from wine to beer, and increased its binge-drinking behaviour. Further studies such as interrupted time-series analyses should test if indeed the hypothesized measures on public health have been effective; this could inform future policies in Spain and in other countries.
Subgroups of adults who drink alcohol at low-risk levels: Diverse drinking patterns and demography
By eboursINTRODUCTION: A significant minority of Australians drink within the 2009 national guidelines. Despite encouragement of low-risk drinking as opposed to consumption patterns associated with greater harm, little is known about the drinking patterns of this group. This paper identifies subgroups of low-risk drinkers and their distinguishable characteristics.
METHODS: Data were sourced from the 2016 National Drug Strategy Household Survey, specifically 8492 adults (18+) who consumed 1-730 Australian standard drinks (ASD; 10 g ethanol) in the past year, and never 5+ ASD on a single occasion. Cluster analysis enabled identification of subgroups from drinking variables. Drinking patterns, socio-demographic characteristics, drinking context and alcohol-related perceptions of subgroups were examined.
RESULTS: Three subgroups were identified. Special occasion drinkers (64.6%) drank low to moderate amounts very infrequently. Regular moderates (19.6%) and Regular sippers (15.8%) drank 5-6 days a week on average, with the average number of ASD per day 1.2 and 0.5, respectively. Special occasion drinkers tended to be younger than members of more regular drinking subgroups. Perceptions of regular alcohol use also differed between Special occasion drinkers and members of the other subgroups.
DISCUSSION: Alcohol consumption patterns among low-risk drinkers are not homogeneous. Younger drinkers who consume at low-risk levels are more likely to report infrequent consumption than moderate regular consumption. A better understanding of low-risk drinkers may help increase the prominence and acceptability of this type of drinking, challenge the normativity of heavier drinking norms and help target campaigns as new information emerges on health risks associated with low-level drinking.
Drinking to excess and the tipping point: An international study of alcohol intoxication in 61,000 people
By eboursBACKGROUND: People who drink alcohol often seek to manage their intake in order to maximise the pleasurable effects, such as feelings of sociability and relaxation, without reaching their 'tipping point', where they feel out of control, or unwell. This paper aimed to explore three stages of intoxication; feeling the effects; being as drunk as you would like to be; and reaching the tipping point (feeling more drunk than you want to be) in a large international sample.
METHODS: The Global Drug Survey (GDS) is an annual, cross-sectional, online survey of drug use. This paper draws on data from 61,043 respondents (63.7% male) from 21 countries who took part in GDS2015 collected in November 2014 to January 2015. Respondents reported their usual type of drink; how many drinks they would require to reach each stage of intoxication and how frequently they reached each stage. Alongside socio-demographic measures, they also completed the Alcohol Use Disorders Identification Test (AUDIT).
RESULTS: Male respondents reported consuming 87.55 gm to be as drunk as they want to be and female respondents reported 70.16 gm, on average. The tipping point was reached at 138.65 gm for male respondents and 106.54 gm for female respondents. Overall 20.3% reported reaching their tipping point at least once a month. Being male, aged under 25 and at higher risk for alcohol use disorder was associated with reporting reaching the tipping point more frequently.
CONCLUSIONS: The amount of alcohol being consumed to reach a desired point of intoxication is much higher than the maximum daily, and sometimes weekly, amount recommended by country guidelines. Encouraging people to avoid reaching their tipping point may be a useful intervention point alongside better communication of low risk drinking guidelines.
Perceived social capital and binge drinking in older adults: The Health and Retirement Study, US data from 2006-2014
By eboursOBJECTIVE: Social capital has been described as having both positive influences as well as negative influences ("the dark side") on health behaviors. We sought to test the association of perceived social capital on the risk of binge drinking among older adults, using a longitudinal design.
METHODS: We used HRS (Health and Retirement Study) data, a nationally representative sample of US adults aged >/=50 years evaluated every two years (from 2006 to 2014). We investigated the relationship between perceived social capital (neighborhood social cohesion and neighborhood physical disorder, positive social support and negative social support) and binge drinking over time, with a multilevel structural equation modelling (MSEM) approach, modelling number of binge-drinking days as hurdle negative binomial. We used MSEM estimating the associations at person level (overall) and within waves.
RESULTS: The sample included 19,140 individuals. At baseline mean age was 66.8 (SD 10.3). Over time, the number of binge drinking days decreased. Negative social support increased the average number of binge drinking days among those who drink, where one unit increase was associated with an increase of 37 % in the expected number of days binge drinking in the same wave. The association of positive social support on the number of binge drinking days was stronger for females (-0.59 (SE = 0.12)), while neighborhood social cohesion was significantly associated with binge drinking in females (-0.05 (SE = 0.01)), but not in males.
CONCLUSIONS: Negative social support favored binge drinking. Positive social support and neighborhood social cohesion are protective factors for binge drinking, especially for women.
Distribution of Drinks Consumed by U.S. Adults by Average Daily Alcohol Consumption: A Comparison of 2 Nationwide Surveys
By eboursINTRODUCTION: Estimates of alcohol consumption in the Behavioral Risk Factor Surveillance System are generally lower than those in other surveys of U.S. adults. This study compares the estimates of adults' drinking patterns and the distribution of drinks consumed by average daily alcohol consumption from 2 nationwide telephone surveys.
METHODS: The 2014-2015 National Alcohol Survey (n=7,067) and the 2015 Behavioral Risk Factor Surveillance System (n=408,069) were used to assess alcohol consumption among adults (>/=18 years), analyzed in 2019. The weighted prevalence of binge-level drinking and the distribution of drinks consumed by average daily alcohol consumption (low, medium, high) were assessed for the previous 12 months using the National Alcohol Survey and the previous 30 days using the Behavioral Risk Factor Surveillance System, stratified by respondents' characteristics.
RESULTS: The prevalence of binge-level drinking in a day was 26.1% for the National Alcohol Survey; the binge drinking prevalence was 17.4% for the Behavioral Risk Factor Surveillance System. The prevalence of high average daily alcohol consumption among current drinkers was 8.2% for the National Alcohol Survey, accounting for 51.0% of total drinks consumed, and 3.3% for the Behavioral Risk Factor Surveillance System, accounting for 27.7% of total drinks consumed.
CONCLUSIONS: National Alcohol Survey yearly prevalence estimates of binge-level drinking in a day and high average daily consumption were consistently greater than Behavioral Risk Factor Surveillance System monthly binge drinking and high average daily consumption prevalence estimates. When planning and evaluating prevention strategies, the impact of different survey designs and methods on estimates of excessive drinking and related harms is important to consider.
Changes in excessive alcohol use among older women across the menopausal transition: a longitudinal analysis of the Study of Women's Health Across the Nation
By eboursBACKGROUND: Recent data suggest that excessive alcohol use is increasing among women and older adults. Such trends are concerning, as women are more vulnerable to alcohol-related health consequences, and such health problems may be exacerbated with age. Furthermore, there are sex-specific factors that may influence alcohol consumption among women, including the hormonal changes associated with the menopausal transition and negative affect. The present study sought to investigate transitions in excessive drinking among women across the menopausal transition and included exploration of sex hormones (estradiol; testosterone) and depression.
METHODS: The present study utilized publicly available data from the Study of Women Across the Nation (SWAN) and included 3302 women (42-52 years old at baseline), who completed 10 years of annual assessments. National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria were used as guidance when defining excessive drinking within the present dataset. At year 1, 170 women were identified as drinking excessively. Random-effect logistic regressions were used to examine transitions in excessive drinking.
RESULTS: Women identified as excessive drinkers were more likely to transition to non-excessive drinking across all menopausal transition stages (ORs range = 3.71-5.11), while women were more likely to transition from non-excessive to excessive drinking during the early peri- and postmenopausal stages (OR = 1.52 and 1.98, respectively). Higher testosterone levels were associated with a decreased likelihood of transitioning to non-excessive drinking (OR = 0.59). Depression and estradiol levels were not related to transitions in drinking.
CONCLUSIONS: The present study demonstrates that the menopausal transition marks a period of instability in alcohol use among women. Further research is warranted to understand factors related to transitioning in and out of excessive drinking.
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Public health groups, researchers, the beverage alcohol industry, and other stakeholders have promoted and applied the concept of "responsible drinking" for the past 50 years. However, little is known about the state of the existing responsible drinking evaluation research and its application to policy and practice.
This project provides a scoping review of studies evaluating responsible drinking interventions. Two primary research questions guided this investigation: (1) To what extent have authors attempted to define the concept of responsible drinking while evaluating responsible drinking interventions? and (2) What is the state of the responsible drinking intervention evaluation literature? We retrieved 49 peer-reviewed articles that evaluated interventions designed to promote "responsible drinking."
Four articles provided, or attempted to provide, an explicit definition of responsible drinking; these four definitions lacked consensus. The existing responsible drinking interventions varied considerably in terms of the messages they attempted to convey (e.g., avoid binge drinking, use protective behavioral strategies, stick to relatively safe drinking limits), again suggesting lack of consensus.
We observed greater consensus concerning the approach to evaluating responsible drinking interventions: studies typically recruited college students to complete brief, well-controlled experiments and measured potential predictors of drinking behavior (e.g., attitudes, expectancies, intentions) rather than actual drinking behavior. We discuss limitations of this methodological approach and the need for greater consensus regarding the concept of responsible drinking.
Why Is Per Capita Consumption Underestimated in Alcohol Surveys? Results from 39 Surveys in 23 European Countries
By eboursAIMS: The aims of the article are (a) to estimate coverage rates (i.e. the proportion of 'real consumption' accounted for by a survey compared with more reliable aggregate consumption data) of the total, the recorded and the beverage-specific annual per capita consumption in 23 European countries, and (b) to investigate differences between regions, and other factors which might be associated with low coverage (prevalence of heavy episodic drinking [HED], survey methodology).
METHODS: Survey data were derived from the Standardised European Alcohol Survey and Harmonising Alcohol-related Measures in European Surveys (number of surveys: 39, years of survey: 2008-2015, adults aged 20-64 years). Coverage rates were calculated at the aggregated level by dividing consumption estimates derived from the surveys by alcohol per capita estimates from a recent global modelling study. Fractional response regression models were used to examine the relative importance of the predictors.
RESULTS: Large variation in coverage across European countries was observed (average total coverage: 36.5, 95% confidence interval [CI] [33.2; 39.8]), with lowest coverage found for spirits consumption (26.3, 95% CI [21.4; 31.3]). Regarding the second aim, the prevalence of HED was associated with wine- and spirits-specific coverage, explaining 10% in the respective variance. However, neither the consideration of regions nor survey methodology explained much of the variance in coverage estimates, regardless of the scenario.
CONCLUSION: The results reiterate that alcohol survey data should not be used to compare or estimate aggregate consumption levels, which may be better reflected by statistics on recorded or total per capita consumption.
Trends in U.S. women's binge drinking in middle adulthood by socioeconomic status, 2006-2018
By eboursBACKGROUND: Binge drinking causes injury and illness. Prevalence of binge drinking doubled in 2006-2018 for women in middle adulthood (ages 30 s and 40 s); these are the first cohorts for whom attaining higher education and income (both associated with increased alcohol use) are highly prevalent. It is unknown whether recent trends in binge drinking among US women aged 30-49 differ by socio-economic status (SES).
METHODS: We examined trends in binge drinking using nationally-representative National Health Interview Surveys (2006-2018) for women age 30-49 (N = 63,426), by education (college) and family income (400 % of poverty line), controlling for age and race.
RESULTS: The odds of binge drinking increased among all women approximately 7 % annually from 2006 to 2018. The magnitude of the change increased with education; the predicted probability of binge drinking among women at lowest levels of education increased from 10 % to 13 % from 2006 to 2018 (adjusted OR [AOR] 1.02, 95 % CI 0.99, 1.04), and those with the highest education from 13%-32% (AOR 1.10, 95 % CI 1.08-1.12). Women at the lowest income increased binge drinking from 12 % to 16 % (AOR 1.03, 95 % CI 1.01-1.05) and highest income from 17 % to 36 % (AOR 1.09, 95 % CI 1.07-1.10). Interactions between education (F855(4), p < 0.001) and income (F857(3), p < 0.001) with time confirmed slope differences.
CONCLUSIONS: Nationally, women at all levels of SES increased binge drinking, but increases were most pronounced among high SES women.
Diverging Trends in the Relationship Between Binge Drinking and Depressive Symptoms Among Adolescents in the U.S. From 1991 Through 2018
By eboursPURPOSE: From 1991 to 2018, binge drinking among U.S. adolescents has precipitously declined; since 2012, depressive symptoms among U.S. adolescents have sharply increased. Binge drinking and depressive symptoms have historically been correlated, thus understanding whether there are dynamic changes in their association informs prevention and intervention.
METHODS: Data were drawn from the U.S. nationally representative cross-sectional Monitoring the Future surveys (1991-2018) among school-attending 12th-grade adolescents (N = 58,444). Binge drinking was measured as any occasion of more than five drinks/past 2 weeks; depressive symptoms were measured with four items (e.g., belief that life is meaningless or hopeless), dichotomized at 75th percentile. Time-varying effect modeling was conducted by sex, race/ethnicity, and parental education.
RESULTS: In 1991, adolescents with high depressive symptoms had 1.74 times the odds of binge drinking (95% confidence interval 1.54-1.97); by 2018, the strength of association between depressive symptoms and binge drinking among 12th(-)grade adolescents declined 24% among girls and 25% among boys. There has been no significant relation between depressive symptoms and binge drinking among boys since 2009; among girls, the relationship has been positive throughout most of the study period, with no significant relationship from 2016 to 2017.
CONCLUSIONS: Diverging trends between depressive symptoms and alcohol use among youth are coupled with declines in the strength of their comorbidity. This suggests that underlying drivers of recent diverging population trends are likely distinct and indicates that the nature of comorbidity between substance use and mental health may need to be reconceptualized for recent and future cohorts.